From The Well…

October 1, 2018



Friday was last day to comment on draft foster care RFP

Friday was the last day for public comment on a draft Request for Proposal the Department of Health and Human Resources will issue “to provide statewide managed care services for youth in the foster care system.”


According to the draft, services to be provided include, but are not limited to:

·    Assisting and reducing the number of children entering the child welfare system

·    Claims management

·    Coordinating and reimbursing for socially necessary services

·    Establishing and managing a credentialed provider network

·    Financial management

·    Maintaining sufficient information systems

·    Member services

·    Quality management

·    Reimbursement for and coordination of physical health services and behavioral health services

·    Utilization management


Vulnerable youth population is defined as

·    Children with a documented case plan with the Bureau for Children and Families

·    Families of children with a documented case plan

·    Foster care children under 45 CFR 1355.20

·    Foster care children under the age of 26 as defined by the Affordable Care Act

·    Post-adoptive children with subsidized care


“For foster care youth that have transitioned to out-of-home placement, many have been exposed to Adverse Childhood Experiences. This results in early toxic stress and trauma and the need for intensive care coordination to help address complex needs of this vulnerable population,” the draft reads.


Thought BubbleDr. Michael Brumage, former executive director and health officer for the Kanawha-Charleston Health Department and currently assistant dean for public health and practice at the West Virginia University School of Public Health, said 506 individuals responded to an online ACE survey that was available at the Kanawha-Charleston Health Department website during most of November 2015. ACE stands for Adverse Childhood Experiences. Brumage said the survey, which was not scientific but designed to provide a community snapshot, showed a higher ACE burden than the original ACE study.


The original study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. It was a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego.           


“Many of the addiction problems we are facing as well as major risk areas for the leading causes of illness and death are caused by adverse experiences in our childhoods,” Brumage said. “This community survey revealed citizens in our area have a high ACE burden in several areas, particularly in regard to children who live in households where at least one parent suffers from mental illness.”


DHHR officials say 85 percent of the 6,000+ children currently in foster care are there because of the state’s ongoing opioid crisis.


“The drug crisis,” DHHR Secretary Bill Crouch said in response to a WSAZ investigation, “has helped fuel a child welfare crisis.”


“There is currently a fragmented system of care for our youth and families at risk. The selected vendor for this procurement will provide services to foster care and at-risk youth and families statewide. A single MCO [Emphasis ours.] will be selected to oversee and coordinate both health and social services,” the draft continues.


Situational awareness: This is a departure from current MCO policies. Medicaid currently deals with four managed care organizations:

Aetna Better Health of West Virginia 

Health Plan of the Upper Ohio Valley


West Virginia Family Health


Not all offer coverage in all counties, as the draft requires. “Given the complex needs of the population to be served, it is encouraged, but not required, that the vendor subcontract with regional child welfare organizations to assist in the care coordination of services for this population, to combine the subject matter expertise of both fields to best meet the holistic needs of our youth. “[Emphasis ours in both instances.]


Situational awareness: This is obviously an appeal to providers who opposed the idea in its infancy. When DHHR Deputy Secretary Jeremiah Samples broached the subject with legislators at a June 25 Legislative Oversight Commission on Health and Human Resources Accountability meeting, two such organizations opposed the concept.


Steve Tuck, executive director of the Children’s Home Society, a foster care agency, said he is concerned an MCO will add an additional layer to the foster care system.


Steve Fairly, executive director of Academy Program, representing the West Virginia Child Care Association, called on DHHR to abandon any move to an MCO.


…And in all this, CMS administrator says audits coming. Fierce Healthcare reports, “Centers for Medicare & Medicaid Services Administrator … Seema Verma issued a warning to Medicaid plan sponsors…, warning the agency would begin targeted financial audits…

“’Transparency must also extend to our health plan partners,’ Verma said during remarks at the 2018 Medicaid Managed Care Summit. ‘This room understands well that nearly all newly eligible individuals in Medicaid are served through managed care organizations. I’m putting you on notice now: CMS will begin targeted audits to ensure that provider claims for actual health care spending matches what the health plans are reporting financially.’”


BPH awards strategic planning contract

The Clarion Group, Ltd., has been awarded contracts totaling $25,000  for developing and documenting the Bureau for Public Health’s strategic planning process as well as facilitating and preparing a strategic planning report. The award was made public on Sept. 25, according to the Department of Administration’s website.


An Internet search shows a Clarion Group, Ltd.,  located in West Hartford, Connecticut.


The bid request addresses BPH’s work to become accredited by the Public Health Accreditation Board. 


“By no later than December 31, 2018 and in accordance with PHAB Measure 5.3.2,” the RFQ for the contract stated, “the vendor shall work with the agency’s strategic planning committee to facilitate the development of and produce a strategic planning report that includes (but is not limited to) the minimum required components. The minimum elements of the process that must be developed and documented by the vendor and provided electronically in both Word and PDF formats…”


BPH Commissioner Dr. Rahul Gupta, who has announced his November departure, recently joined the PHAB Board of Directors



No nationally recognized standard for drugged driving. NCSL reports, “The nationally recognized level of impairment for drunken driving is .08 g/mL blood alcohol concentration. But there is no similar national standard for drugged driving. Drugs do not affect people consistently; a high concentration may significantly impair one person but not another.”


Tennessee Public Health issues marijuana advisory. The Tennessee Department of Public Health reports, “The Tennessee Department of Health is issuing a public health and safety advisory to warn Tennesseans about the risks of harm associated with use of products derived from Cannabis, including marijuana and hemp that claim to benefit health.”



Medicare easing up on safety-net hospital readmission policies. Kaiser Health Network reports, “On orders from Congress, Medicare is easing up on its annual readmission penalties on hundreds of hospitals serving the most low-income residents…

“But starting next month, lawmakers mandated that Medicare take into account a long-standing complaint from safety-net hospitals. They have argued that their patients are more likely to suffer complications after leaving the hospital through no fault of the institutions, but rather because they cannot afford medications or don’t have regular doctors to monitor their recoveries”



Wheeling Island, Mardi Gras, delay sports betting. The Gazette-Mail reports, “Launches of sports bettingat Wheeling Island and Mardi Gras casinos, tentatively expected by the end of this month, have been delayed…”



AMA policy says any changes to Medicaid financing should not undermine coverage gained under ACA. The American Medical Association reports, “The Affordable Care Act allowed states to expand Medicaid eligibility to include nonelderly adults with incomes of up to 138 percent of the federal poverty level. About 12 million newly eligible individuals enrolled in the program in the 31 states and District of Columbia that expanded Medicaid coverage.


“Long-standing AMA policy advocates access to adequate health care coverage for all and that any changes to Medicaid financing should not undermine coverage gains that occurred under the ACA—particularly for individuals with the lowest incomes.


Last year’s flu kills 80K, highest in four decades. Axios reports, “Last season’s flu epidemic is estimated to have killed 80,000 Americans — the highest level for at least four decades, Robert Redfield, director of the Centers for Disease Control and Prevention, told the Associated Press in an interview. It also caused the deaths of at least 180 children, 80% of whom were not vaccinated, per the CDC.”


…Some opt out. Bloomberg Law reports, “More Americans could opt out of flu shots this year, potentially driving up cases of a disease that already infects millions and costs the economy billions.”


…Risks of heart attack and stroke may increase. CNBC reports, “But after a historically severe season, public health researchers are warning it’s even worse than many think, leading to increased risk of heart attack and stroke during recovery and an inability for some older people to recover completely.”